Client Forms

If you are interested in the counseling services of Ellis Counseling, please take a moment to download and fill out our new client intake form. We also have copies available at our clinic; however, filling out the form beforehand will save time at your first visit.

Insurance Questions and coverage
Authorization to Release Records
Informed Consent for Teletherapy Services

Adult Forms

HIPPA Privacy Notice for Ellis Counseling, LLC March 09
Info on Patients Rights for HIPPA with Signature of Notice
Ellis Counseling Intake Form
Ellis Counseling Informed Consent
Consent to file insurance

Child and Adolescent Forms

HIPPA Privacy Notice for Ellis Counseling, LLC March 09
Info on Patients Rights for HIPPA with Signature of Notice
AUTHORIZATION FOR COUNSELING SERVICES for minors
Ellis Counseling Child-Adolescent Intake Form
Ellis Counseling Informed Consent
Adolescent Informed Consent Form (Ages 14 and above)
Consent to file insurance

Couples Forms

HIPPA Privacy Notice for Ellis Counseling, LLC March 09
Info on Patients Rights for HIPPA with Signature of Notice
Ellis Counseling Intake Form
Ellis Counseling Informed Consent
Couple Informed Consent
Consent to file insurance